Fertility Problems

Fertility Problems: Free advice – ask me today!

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By Dr Helen Webberley MBChB MRCGP MFSRH | GMC no. 3657058

I am a GP and a sexual health and hormone specialist. I can give advice on any medical matter, and I offer safe access to medical advice, prescription medication, blood tests and x-rays, and specialist referrals to your local private hospital as needed.

Fertility Problems

Male infertility can be quite complex and a challenge to treat. Evidence suggests that with infertile couples, abnormalities can occur in 1 in 4 males. About 15% of couples report infertility but only about 5% remain childless. There are multiple potential causes, including poor lifestyle, genetic abnormalities, hormonal problems, anatomical abnormalities, infections, drugs and immunological disorders.

There are no good studies to show how effective these treatments are although treatments with Clomid and HCG have shown benefits.

We can help as much as possible but unfortunately there are no guarantees.

Frequently Asked Questions

My sperm count is poor, what can I do to improve it?

There may be lots of reasons why your sperm count is poor, some of which may be treatable and some not. We generally advise changes in lifestyle, to include stopping smoking, cutting back on alcohol, maintaining healthy weight, eating healthily and getting a good night’s sleep. Although exercise is also recommended, there are certain sporting activities that might impair sperm production, in particular cycling, long distance running and extreme fitness training. The use of anabolic steroids significantly reduces sperm quality.

Any activity which increases testicular temperatures (such as wearing tight underwear or thermal underwear, regular use of hot tubs and saunas) should also be avoided.

If these adaptations do not help, you may need further investigation and treatment.

Do vitamins help my infertility?

In general we recommend a healthy lifestyle to include a healthy diet, rich in vitamins.

In addition, treatment with antioxidants, including folic acid (vitamin B9), vitamin E, zinc and selenium, have been shown to improve sperm quality and subsequent likelihood of conceiving.

Should I have any special tests for my poor sperm count?

If your count is really low (less than 1 million per ml) or associated with very poor motility and abnormal forms, then you should have a full physical examination by an experienced doctor and a test of your hormones and genes, to make sure there are no anatomical, hormonal or genetic abnormalities.

We may also recommend an ultrasound of your scrotum, testicles and prostate to exclude any physical abnormalities.

Most men however, have only mild abnormalities in their sperm counts which do not need specialised tests.

My wife and I have both had tests for infertility but they were all normal

Some couples experience ‘unexplained infertility’ where all conventional fertility tests are normal. This may be very upsetting for couples but many of them go on to conceive normally with a little help. Clomid can be beneficial in women even when they seem to be ovulating normally. Clomid and tamoxifen have also been shown to be helpful in men even when sperm tests are apparently normal.

What blood tests should I have if I have a low sperm count?

We would recommend the following blood tests to investigate a low sperm count.

Serum testosterone (the male hormone)

Serum oestrogen (the female hormone)

FSH and LH (to make sure the pituitary is working normally)

Prolactin ( this hormone can be elevated in some men and may need medical treatment to control)

What drug treatments are available to help male infertility?

If your testosterone levels are low or at the lower level of the normal range, we would recommend testosterone therapy, either by injection or as a gel which you rub on the skin.

HCG injections may also be required whilst on testosterone, to maintain testicular volume and to improve the sperm count

Clomid taken daily has been shown to improve male fertility

Tamoxifen taken daily has also been shown to improve male fertility

If oestrogen levels are high then aromatase inhibitors (such as anastrozole and letrozole), may help to correct the hormonal imbalance

If prolactin levels are high then medications such as cabergoline are occasionally needed to reduce the levels

hMG injections (human menopausal gonadotropin) is helpful in men and women and may occasionally be prescribed but is very expensive.

Treatments

Clomid and tamoxifen

Both of these medications are ‘anti-oestrogen’ in other words they block the effect of the female hormone oestrogen. They actually work, not by reducing oestrogen levels, but by blocking the receptors on cells that oestrogen attaches to, therefore not allowing oestrogen to exert its effect.

Testosterone

This is the male hormone that stimulates sperm production. If your levels are low (or at the lower end of the normal range), testosterone therapy can help to improve sperm production. This can be administered either by injection or by rubbing gel on the skin.

hCG injections

hCG stands for human chorionic gonadotropin.
If the pituitary hormone levels are low, or you have had to start testosterone replacement therapy, hCG may be used to stimulate the testicles, which has the effect of maintaining testicular volume (which can drop off with testosterone therapy) and to stimulate sperm production.

Anastrozole

This is an aromatase inhibitor. Sometimes too much testosterone is converted to oestrogen by the aromatase enzymes. This brings about an imbalance in hormone levels, with higher oestrogen and lower testosterone levels. These drugs prevent this from happening.

Safe, real prescriptions for Fertility Problems.

Blood Tests

Testosterone and oestrogen

It is important to exclude a hormonal imbalance, both low testosterone and high oestrogen levels may independently cause infertility. This can be controlled with medication

FSH/LH

These are hormones which are released from the pituitary gland in the brain, that stimulate the testicles to produce testosterone and sperm. High levels of these hormones may suggest an underlying testicular problem (as the pituitary is having to work harder) and low levels may suggest an underlying pituitary problem.

Prolactin

This is another hormone produced in the pituitary that if elevated, causes poor testicular function, including reduced testosterone and sperm production. This may need special medication to reduce levels.